title: Factors associated with presence and extent of coronary calcium in those predicted to be at low risk according to Framingham risk score (from the Multi-Ethnic Study of Atherosclerosis).
abstract: Even among asymptomatic persons at low risk (<10%) according to the Framingham risk score, high coronary artery calcium (CAC) scores signify a greater predicted risk of coronary heart disease events. We sought to determine the noninvasive factors (without radiation exposure) significantly associated with CAC in low-risk, asymptomatic persons. In a cross-sectional analysis, we studied 3,046 participants from the Multi-Ethnic Study of Atherosclerosis at a low 10-year predicted risk (Framingham risk score <10%) of coronary heart disease events. Multivariate logistic regression analysis was used to assess the association of novel markers with the presence of any CAC (CAC >0) and advanced CAC (CAC ≥ 300). A CAC level of >0 and of ≥ 300 was present in 30% and 3.5% of participants, respectively. Factor VIIIc, fibrinogen, and soluble intercellular adhesion molecule were each associated with the presence of CAC (p ≤ 0.02), and C-reactive protein, D-dimer, and the carotid intima-media thickness with advanced CAC (p ≤ 0.03). The base model combining the traditional risk factors had excellent discrimination for advanced CAC (C-statistic 0.808). The addition of the 2 best-fit models combining the biomarkers with or without carotid intima-media thickness improved the c-statistic to 0.822 and 0.820, respectively. All 3 models calibrated well but were similar in estimating the individual risk probabilities for advanced CAC (prevalence 9.97%, 10.63%, and 10.10% in the greatest quartiles of predicted probabilities vs 0.26%, 0.26%, and 0.26% in the lowest quartiles, respectively). In conclusion, in low-risk persons, the traditional risk factors alone predicted advanced CAC with high discrimination and calibration. The biomarker combinations with and without carotid intima-media thickness were also significantly associated with advanced CAC; however, the improvement in the prediction and estimation of the clinical risk were modest compared to the traditional risk factors alone.
authors.affiliation: Division of Cardiology, Wayne State University School of Medicine, Detroit, MI, USA.
authors.forename: Tochi M
authors.initials: TM
authors.lastname: Okwuosa
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
authors.forename: Susan G
authors.initials: SG
authors.lastname: Lakoski
authors.forename: Hongyan
authors.initials: H
authors.lastname: Ning
authors.forename: Joseph
authors.initials: J
authors.lastname: Kang
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.forename: John R
authors.initials: JR
authors.lastname: Crouse
authors.forename: Joao A C
authors.initials: JA
authors.lastname: Lima
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: Donald M
authors.initials: DM
authors.lastname: Lloyd-Jones
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D002114:Calcinosis / Q000453:epidemiology* / Q000208:ethnology / Q000473:pathology; D003327:Coronary Disease / Q000453:epidemiology* / Q000208:ethnology / Q000473:pathology; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers